When should PAD programs be considered?

According to the AHA, PAD programs should be considered when “An EMS call–to-shock time interval of <5 minutes cannot be reliably achieved with conventional EMS services.” Are you aware of any EMS systems that can produce a “call-to-shock” time of less than 5 minutes? Remember, this is “call-to-shock” not call-to-arrival-to-the-scene or even call-to-applying pads…As such, I’d argue that it is virtually impossible for an EMS system to deliver defibrillation therapy less than 5 minutes after a call.

While there is no standard for EMS response times (and here), most EMS and fire agencies set goals ranging form 6 to 8 minutes. In San Francisco, for example, SF fire has a goal of responding to over 80% of their calls within 6 and 1/2 minutes. According to a report, “The city’s objectives also are less rigorous than standards set by the National Fire Protection Association, which call for arrival on the scene within 6 minutes after a 911 medical call is answered.” In SF, first responders arrive on scene in 8 minutes or less 90 percent of the time – falling short of the city’s goal by up to 1 1/2 minutes.

So, if (a) San Francisco’s goal is to arrive within 6 1/2 minutes, over 1 1/2 minutes LATER than the AHA goal for EMS systems and (b) San Francisco is not meeting its own goal the majority of the time, then (c) a comprehensive community-based PAD program is needed in San Francisco (and any other community with similar response rates).

Additionally, San Francisco, and all other communities do not measure their response times based on “call-to-shock” but, typically, call to arrival on scene. Thus, its likely even further delays exist beyond the “call-to-shock” timeframe, evidence of an even greater need for a comprehensive PAD program.